#53: Daniela Wittmann - Prostate Cancer and Sex

My guest Daniela Wittmann is an expert on prostate health and urology. In fact, she is a very prominent member of the Prostate Cancer Survivorship Program; in addition, she is an associate professor of Urology and Social Work in the University of Michigan Health System.

In this interview, she informs listeners on prostate health and penile rehabilitation--particularly after surgery, radiation, or hormone treatment for males who have had prostate cancer.

It is a very informative and important talk, and even if you aren’t currently going through the complications of prostate cancer, getting a jumpstart on learning about the subject is very important.

Screening for Prostate Cancer

As Daniela states, prostate cancer is asymptomatic, which means that symptoms don’t show up until well after it has already metastasized or shown up in the prostate. It is screened, if there are abnormalities caught in the screen then a biopsy is usually done and then a number of treatment options are available as a next step. Daniela goes into more detail during the episode.

Treatment Options That Affect Sexual Functioning

If non-aggressive and very localized, men can always go under ‘active surveillance.’ At this point, physicians simply monitor and watch to see if the cancer gets more aggressive. This treatment method has no sexual side effects.

Another treatment is when the cancer is localized, so treatment typically centers around radiation or surgery. Side effects do occur with this type of treatment. For most men, after they do the surgery, they will experience erectile dysfunction because the nerves responsible for making the penis erect are damaged during surgery. In addition, urinary incontinence can occur as well.

For more information on treatment options, as well as the side effects of radiation, Daniella provides a succinct breakdown of the treatment options.

Men Resisting or Putting Off Treatment?

Because there are considerable side effects like loss of libido, lower testosterone, and impaired erectile function, to name a few, some men choose to resist treatment. Daniela states that there are a number of studies which show that men choose not to get treatment because of how daunting the choice can be. Of course, one would want to treat cancer, but to lose sexual function is not attractive to anyone. Some men choose to only monitor their cancer and wait until it gets much worse.

Things to Be Aware Of

Among many other facets, Daniela stresses the importance of communicating concerns about loss of sexual function to your physician. But as she says, when it comes to cancer, many physicians downplay the importance of communicating sexual side effects because cancer is the far more serious factor at play. As a result, Daniela says that many men are often surprised by the side effects after treatment. Communication is key between patient and physician.

Also requesting to the surgeon that as many nerves be spared as possible during surgery, is a very important thing to consider.

What Does Penile Rehabilitation Look Like?

Penile rehabilitation in this context means to protect the penile tissue from atrophying. Daniela highlights a number of strategies that are used to accomplish this: low doses of Viagra or Cialis to breathe oxygen and blood into the penis; another is penile injections which do the same thing, and stimulation of the nerves in the penis to maintain penile tissue. For erections, a vacuum pump can be used to maintain a hard erection as well. And all of this is used to maintain the ability for sexual function once the penis has been rehabilitated enough. For much more, tune in.

Recommended Time Rehabilitating and The Frequency

Although Daniela says that there is no conclusive time period that one should most effectively rehabilitate, the minimum amount of time should be about three-six months or so. “And the frequency,” you might ask? Although there isn’t an exact, prescribed standard that physicians recommend, for Daniela, she states that 3x a week is what she asks of her patients. As well as have orgasms through masturbation or with the help of a partner 3-4 times a week. She goes into more detail during the interview.

Advice for Couples

Daniela preaches the importance of patience. For those who are still wanting to be sexually active in their relationships, the erections take time to come back. Patience is key. She encourages understanding between couples and support with orgasms and erections. Don’t over-focus on penetration; look to oral sex and other methods as well. It is a challenge but being flexible and shifting sexual priority is very important.

Final Thoughts

Daniela stresses the importance of communicating with one another during the sexual difficulties that often occur after surgery. Because it can be easy to not talk about it while things are healthy and working smoothly, learning how to communicate is one of the most important facets of the whole process. And for her final closing thought, really listen in and take in all that she has to say on this very important topic. Check the links below to learn more about Daniela.

Key Links for Daniela Wittmann

Daniela's Bio and University of Michigan Information:

https://medicine.umich.edu/dept/urology/daniela-wittmann-phd-lmsw

Prostate Survivorship Program:

https://www.rogelcancercenter.org/prostate-cancer/survivorship

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